Provider Demographics
NPI:1336504869
Name:GEHAN EMARA JALLAQ DDS LLC
Entity Type:Organization
Organization Name:GEHAN EMARA JALLAQ DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EMARA JALLQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-275-0800
Mailing Address - Street 1:4206 WESTVIEW CENTER PLZ
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-2975
Mailing Address - Country:US
Mailing Address - Phone:614-275-0800
Mailing Address - Fax:614-275-0804
Practice Address - Street 1:4206 WESTVIEW CENTER PLZ
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-2975
Practice Address - Country:US
Practice Address - Phone:614-275-0800
Practice Address - Fax:614-275-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty